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The chest pain checklist

The aim of this blog post is to provide you, our dear reader, some important facts and points about chest pain and thereby empower you to take the right decision when you or your loved one encounters it.

Chest pain is probably the most feared of all pains, mainly due to its association with heart problems. In fact, it is the second most common reason for presenting to the hospital emergency department across the globe (injury being the leading cause). Here are 5 common causes of chest pain and some tips to differentiate one from the other:

  1. Gastric acidity or heartburn
  2. Heart attack or angina
  3. Lung related causes
  4. Musculoskeletal problems
  5. Neurological pain

Gastric acidity or heartburn

Gastric acidity is also referred to as heartburn because it causes a burning sensation in the middle portion of the chest, typically behind the chest bone. The rising up of gastric juices from the stomach to the tube connecting the mouth and stomach (esophagus) and irritation of the inner lining of the tube is the cause for this burning sensation.

A few indicators of heartburn are:

  • Timing of the pain – the pain might occur before a meal if you often have untimely meals or skip meals
  • Association with food types – heavy meals or food with excessive oil and spice might trigger the discomfort
  • Response to antacids – if the pain or burning sensation subsides with over-the-counter liquids or tablets for acidity, it is likely a heartburn

Heart attack or angina

Chest pain due to cardiac causes can be very severe and sinister. It is important to know that the following causes may lead to cardiac related chest pain:

  • Sudden unbearable pain in the chest or upper part of the body due to a complete block of the blood vessel supplying the heart (myocardial infarction or heart attack)
  • A gradually building up chest pain which worsens during exercise or emotional bursts and gets relieved with rest or relaxation is called angina and is due to poor blood supply to the heart
  • A stabbing or piercing pain of the chest may be due to a tear of the major blood vessel leaving the heart or disease of the covering of the heart

Note: As heartburn and heart attack pain can mimic each other, it is best to see a doctor and get an electrocardiogram or ECG test at the earliest. Also, a healthy lifestyle which includes a balanced healthy diet in a timely manner, regular exercise and stress relieving techniques such as yoga, meditation and deep breathing, is extremely effective in keeping both heart related and gastric acidity related problems at bay.

Lung related causes

A few conditions like infection of the lungs, inflammation of the covering layer of the lungs, block in the artery supplying blood to the lungs and high blood pressure in the blood vessels carrying blood to the lungs can cause chest pain. The clues here are pain that worsens with deep breathing or coughing and at times associated with shortness of breath. As some of the causes are potentially lethal, it is imperative to consult a physician if the pain is severe or associated with difficulty breathing.

Musculoskeletal problems

Injuries to the muscles in the chest region or the ribs and the surrounding cartilages can cause chest pain. Pain on pressing a particular spot, also called tenderness, is an indicator of an underlying soft tissue or bony problem. The pain usually gets better with application of cold or hot fomentation or with anti-inflammatory drugs if it is soft tissue related.

Neurological pain

Any radiating pain in the neck, upper chest, upper back and arm can be due to nerve compression. The severity of pain may be more with upper body and arm movements and may be associated with other symptoms like tingling sensation, numbness etc.

Panic attack is another well-known cause of chest pain. You might not have any of the problems mentioned above but may experience a severe chest pain together with intense fear, rapid heartbeat, rapid breathing, profuse sweating, nausea and dizziness.

Shingles or herpes zoster infection of the chest region can cause a severe chest pain along with a band of blisters from the back to the front of the chest.

While chest pain may be due a variety of causes, cardiac and certain lung causes may be life threatening and should be addressed immediately without any time delay. So, here is the checklist for someone experiencing chest pain:

  • Is this a new-onset pain?
  • Is the pain severe or unbearable?
  • Is the pain radiating (spreading from one point to other areas)?
  • Is the pain associated with exercise or emotions?
  • Is the pain associated with meals, cough, deep breathing etc?
  • Is the pain getting better with over-the-counter drugs?
  • Is the pain lasting for days to weeks?
  • Is the pain getting better with local application of muscle relaxants or cold/hot fomentation?

While this post may come in handy when someone you know has chest pain, we strongly recommend consulting your physician to rule out serious medical conditions.

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Yes it is proven: Blocks can disappear

One or more blocks in the blood vessels supplying the heart muscle is known as coronary artery disease. Severe coronary artery disease is the culprit in the majority of heart attacks. It is a combination of cholesterol deposits and blood clots in the inner lining of the blood vessels that usually prevents blood flow and causes heart muscle damage. As soon as someone is diagnosed with a heart attack, the emergency medical team rushes to give intravenous medications to stop the blood clot from growing and takes immediate steps to restore the blood flow through a stent procedure or surgery. While this often saves heart muscle as well as lives, a long-term approach to disease management is equally important. Let us see why.

The most common question that our patients ask us is “will the blocks inside my coronaries go away or are they permanent?” The answer to that is “yes it’s proven that blocks inside coronaries can disappear with time but here is what you need to know…”

  • Coronary blocks get formed over a period of months to years, so it takes time to regress and disappear
  • The younger the person the more likely that the blocks will regress
  • Hardened blocks due to calcium deposits are less likely to regress
  • Most importantly, intensive lifestyle modification in combination with cardio-protective drugs has been proven to cause regression and disappearance of blocks

Smoking cessation, regular exercise, a heart-healthy diet, stress management, health education and counseling are all part of the disease reversal strategy in a cardiac rehabilitation program. While strong evidence is available to support this phenomenon of coronary artery disease regression from developed countries, we are the first to have published our experience on Indian patients recently (https://www.ncbi.nlm.nih.gov/pubmed/27133332).

How a coronary block develops. (1) normal blood flow (2) reduced blood flow due to fatty deposits (3) complete block due to rupture of fatty deposit combined with a blood clot

Take home message 1: Never too old

If you are a senior citizen reading this post, you are probably wondering if disease regression is possible in your age group. While younger men and women have a higher likelihood of disease reversal, it has been proven beyond doubt that intensive lifestyle modification has benefits in all age groups. It can halt the growth of the coronary blocks and aid in the development of newer blood vessels or ‘natural by-passes’ to compensate for the reduced blood flow.

Take home message 2: Never too young

The latest guidelines for the prevention of cardiovascular disease conclude that a healthy lifestyle should be adopted as early as from the age of 5 years. So if you have young children or are a young adult thinking of starting a family, it is important to keep in mind that healthy lifestyle behaviors have to be incorporated in your everyday living rather than on an occasional basis.

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Knowledge-sharing: the essence of effective Cardiac Rehabilitation

Education or knowledge-sharing is the most important aspect of Cardiac Prevention and Rehabilitation Programs. For someone who has had a heart attack or myocardial infarction, having a reliable and knowledgeable professional to talk to and get answers to some pertinent questions makes a big difference. This is what health education is all about. The British Association of Cardiovascular Disease Prevention and Rehabilitation very aptly describes the 6 core components in this artwork:

Health behaviour change, which is the first and fundamental step in improving the cardiac and overall wellbeing, depends hugely on proper education. Let us take the common example of hypertension. We all know that high blood pressure is not good for our body and most of us are also aware that reducing salt intake can help reduce our blood pressure. However, only when an experienced dietician understands the food pattern of an individual and educates him/her about obvious and hidden salt in our daily diet, the simple ways by which salt can be cut-down in the household and what are the alternative ingredients that can be used to enhance taste in low-salt cooking, that person is actually able to make that particular health behaviour change of reducing salt in their diet and sustaining that change.

cardiacwellnessinstitute.com/images/issaltavillain.pdf

The healthcare team at Cardiac Wellness Institute is not only involved in educating patients and their families about the risk factor management, heart-healthy nutrition and exercise principles but is also actively engaged in training healthcare professionals from other parts of India so that more such comprehensive and high-quality cardiac rehab services become available to the people who need it, close to wherever they live.

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The sweet danger of sugar

Would you like to understand ‘sugar’ better? While you might know that sugar is really sweet and enhances taste did you know that it can be dangerous too? Let me take you through some basic facts about sugar before seeing the health hazards of this sweet ingredient…

Sugars are broadly grouped into simple and complex sugars, and natural and added sugars.

Simple Sugars

Simple sugars are carbohydrates that are quickly absorbed by the body to produce energy. These sugars are present in both natural and processed foods. Natural foods that contain simple sugars include fruits, vegetables and milk products. Processed foods often have simple or refined sugars added to improve flavour. Examples of refined-sugar foods include candy, cakes, syrups, fruit juices and carbonated beverages.

Complex Sugars

Complex sugars are complex carbohydrates that take a longer time to digest as they are packed with fibre, vitamins and minerals. Examples are cereals, legumes, whole wheat pasta and vegetables.

Natural sugar

Natural sugar is naturally occurring, which makes them healthy. There are two types of natural sugars.

  1. Fructose – it is found in fruits
  2. Lactose – it is found in dairy products. These nutrients help to stabilize your blood sugar levels, which prevents you from feeling hungry soon after eating.

Added sugar

Added sugars are sugar carbohydrates added to foods and beverages during their processing. This does not include naturally occurring sugars such as those in milk and fruits. It provides empty calories that are of no benefit  to your body. Examples are candy, cake, soft drinks, ice cream and other desserts. Consuming too much added sugar is a health hazard!

Sugar, honey and jaggery are the commonly used sweetening agents added to beverages and foods to increase palatability. The crystallised sugar we all keep in our kitchen shelves is made up of glucose and fructose. It’s a source of energy providing 4 kilocalories per gram. Jaggery is made from sugar cane juice after processing it and is a fair source of iron. Honey is the golden coloured syrup made by bees from the nectar of flowers. It also consists of glucose and fructose.

How much sugar can be consumed on a daily basis?

While theoretically, a normal healthy adult can consume 24 grams (or) 6 teaspoons per day, research reveals that minimal or zero added sugar is best for our health. Diabetic patients, however, have a reduced ability to metabolise sugar and should strictly avoid all forms of added sugar.

How many calories does one teaspoon of sugar contain?

Amount         –  1tsp (4.2g)

Calories          – 16 kcals

Carbohydrate  – 4.2 g

Health risks of eating too much sugar

Sugar, an instant source of energy, can lead to multiple health problems if consumed in large quantities: weight gain, fatty liver disease, diabetes, hypertension, heart attack, stroke and kidney failure are some of the common ailments caused by this sweet substance.

Artificial sweeteners

Artificial sweeteners, also referred to as sugar substitutes, are used to replace sugar in foods and beverages. Sucralose, aspartame and saccharin are the mostly purchased artificial sweeteners, especially by diabetic individuals. We will look at these agents in depth in a future blog post, but it is apt to say that their use should be minimised keeping in mind their harmful side effects.

So, here are some tips to cut down on sugar in your daily diet:

  • Instead of adding sugar to cereal or oatmeal, add fresh fruits (try bananas, pomegranate or berries) or dried fruit (raisins, cranberries or apricots).
  • If you consume tea, coffee or milk with added sugar, try alternatives like green tea, black coffee and unsweetened milk.
  • Instead of adding sugar in recipes, use extracts such as almond, vanilla, orange or lemon.
  • Enhance the taste of foods with spices instead of sugar; try ginger, allspice, cinnamon or nutmeg.
  • Compare the sugar content of different foods and choose the lower sugar and calorie option.

“ Eat less SUGAR;

You’re SWEET enough already”

 

 

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Understanding the difference between heart attack and cardiac arrest

If you are under the impression that a heart attack and a cardiac arrest are the same, you are mistaken. Both these terms refer to different conditions of the heart; let us see how.

Heart attack: sequence of events

When someone has reduced or lack of blood flow in the blood vessels supplying the heart muscle, or in other words, one or more critical block(s) in the coronary arteries leading to deficient oxygen supply to the myocardium, the individual is said to have a heart attack.

This usually manifests as chest pain, chest tightness, lower jaw, neck or upper back discomfort or heartburn. Breathlessness, giddiness, excessive sweating, nausea and vomiting can accompany the pain or be lone symptoms. Silent attacks can occur too.

A heart attack (or myocardial infarction) can lead to a cardiac arrest.

So what is a cardiac arrest?

A cardiac arrest is when the heart suddenly stops pumping blood, mostly due to abnormal electrical signals or arrhythmias within the heart. There is a sudden lack of blood supply to all the body parts including the brain leading to a loss of consciousness and collapse.

Cardiac arrest is a deadly condition, which can lead to death within a few seconds to minutes. By providing immediate cardiopulmonary resuscitation (CPR) and defibrillation, a cardiac arrest can be reversed. An automated external defibrillator or AED is available in many public facilities these days for this purpose. However, only people trained in CPR and emergency healthcare should volunteer to resuscitate someone, as incorrect maneuvers can be dangerous.

There are several reasons for a cardiac arrest; the commonest is a heart attack.

Some other causes of cardiac arrest are cardiomyopathy (due to diabetes, hypertension or other causes), heart failure, valve abnormalities, abnormally formed coronary arteries, recreational drug use, certain medications, certain electrical abnormalities of the heart like Wolff-Parkinson-White Syndrome and inherited genetic abnormalities like Long QT Syndrome.

Important points to note:

  • Heart attack leads to death of heart muscle tissue which if untreated can lead to death of the individual; however, a massive heart attack can cause instant death. Whether sudden or not, the usual mechanism of death following a heart attack is cardiac arrest.
  • Cardiac arrest is a deadly condition that can cause death in a matter of seconds to minutes; immediate CPR can reverse the arrest.
  • Treatment for someone who has had a heart attack often includes lifestyle modification, medicines, angioplasty or bypass surgery and cardiac rehabilitation.
  • A cardiac arrest survivor is managed with lifestyle advice, medicines, cardiac device like pacemaker or implantable cardioverter defibrillator (ICD), surgical denervation if necessary and cardiac rehabilitation.
  • Sudden cardiac arrest or death in a healthy individual below 40 years of age may be due to a genetic cause; thorough evaluation by a cardio-genetic team often helps prevent future arrest/death.
  • Both heart attack and cardiac arrest are preventable by healthy lifestyle, regular health checks and adherence to medication.

The healthcare team at Cardiac Wellness Institute provides comprehensive services for individuals and families with heart attack and cardiac arrest; you may contact us for any further questions or clarifications.